Human Trafficking ICD-10 Code Utilization in Pediatric Tertiary Care Centers Within the United States

Abstract

BackgroundHuman trafficking is a global public health issue that affects pediatric patients widely. The International Labor Organization estimates children comprise approximately 25% of the identified trafficked persons globally, with domestic estimates including over 2000 children a year. Trafficked children experience a broad range of health consequences leading to interface with healthcare systems during their exploitation. In June 2018, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) released diagnostic codes for human trafficking.ObjectiveTo use a large, multicenter database of US pediatric hospitalizations to describe the utilization of the ICD-10-CM codes related to child trafficking, as well as the demographic and clinical characteristics of these children.MethodsThis study was descriptive in nature. Encounters using data from the Pediatric Health Information System database (PHIS) with ICD-10-CM codes indicating trafficking from June 1, 2018 to March 1st, 2020 were included in the study cohort, with data collection continuing for 30 days after first hospital encounter, until March 31st, 2020. Patients 19 years old and younger were included. Condition-specific prevalence as well as demographic and clinical characteristics for patient encounters were analyzed. Study subjects were followed for 30 days after first hospital encounter to describe healthcare utilization patterns.ResultsDuring the study period, 0.005% (n = 293) of patient encounters in the PHIS database were identified as trafficked children. The children of our cohort were mostly female (90%), non-Hispanic Black (38%), and had public insurance (59%). Nearly two-thirds of patients (n = 190) had a documented mental health disorder at the initial encounter, with 32.1% classified as the principal diagnosis. Our cohort had a 30-day hospital inpatient, overnight observation, or emergency department readmission rate of 16% (n = 48).DiscussionOur study demonstrates a low utilization of human trafficking ICD-10-CM codes in academic children's health centers, with code usage predominantly assigned to Non-Hispanic Black teenage girls. As comparison, in 2019 the National Human Trafficking Hotline identified 2,582 trafficked US children in a single year. These results suggest widespread under-recognition of child trafficking in health care settings, including the intensive care unit, in addition to racial and socioeconomic disparities amongst trafficked children.

Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes

“…We found that the population is predominantly young and female, consistent with reports in the US and some other regions [20]. The population was found to be slightly older and racially more White than reported in an earlier study [17], likely because it utilized data from urban pediatric tertiary medical centers. Generally speaking, it was surprising to see so many victims in our database, which includes just persons holding commercial or government-provided insurance, as it runs counter to the view that few victims would have insurance of any kind.…”

“…Because administrative claims data is used for billing, providers might be using more conventional codes where they are more certain of receiving payment. Additionally, patients and providers might be concerned about whether the trafficker has access to the medical records of the patient or not, which might make the providers hesitant about using the new ICD-10 codes [17]. But we hypothesize that the lack of awareness and absence of institutional policies are the primary causes of underreporting.…”

“…Through access to a large multi-state database of medical claims, we were also able to create a detailed picture of this population’s medical needs across multiple jurisdictions and medical settings. The largest previous study [17] included only 293 patients received at pediatric tertiary centers during individual hospital encounters, while this study captured 2301 patients identified across all care settings, and included 1025 patients with a recent exploitation event who were tracked over two years.…”

“…The literature review with Pubmed, Scopus, Web of Science and Google Scholar shows that there have been few studies based on the new ICD-10 codes. The largest study to date characterized the victims in major pediatric medical centers [17], but was on a much smaller set of cases (n=293) than here, and it was specifically children-focused, and included only major urban centers. Additionally, a small study (n=23) reported on how the codes were used to better identify sexually exploited youth and young adults in Minnesota [18].…”

Victims of human trafficking and exploitation in the healthcare system: a retrospective study using a large multi-state dataset and ICD-10 codes

“…Our literature review with Pubmed, Scopus, Web of Science, and Google Scholar shows that there have been few studies based on the new ICD-10 codes. The two largest previous studies utilizing these codes relied on 49 pediatric tertiary centers ( 16 ) and 48 healthcare organizations ( 17 ). Another study ( 18 ) interviewed providers and examined their awareness of human trafficking but did not quantify the characteristics of the trafficked population.…”